Over the last decade, it has become clear that the role of angiotensin II extends far beyond recognized renal and cardiovascular effects. The presence of an autologous renin-angiotensin system has been demonstrated in almost all tissues of the body. It is now known that angiotensin II acts both independently and in synergy with TGF-beta to induce fibrosis via the angiotensin type 1 receptor (AT1) in a multitude of tissues outside of the cardiovascular and renal systems, including pulmonary fibrosis, intra-abdominal fibrosis, and systemic sclerosis. Interestingly, recent studies have described a paradoxically regenerative effect of the angiotensin system via stimulation of the angiotensin type 2 receptor (AT2). Activation of AT2 has been shown to ameliorate fibrosis in animal models of skeletal muscle, gastrointestinal, and neurologic diseases. Clinical reports suggest a beneficial role for modulation of angiotensin II signaling in cutaneous scarring. This article reviews current knowledge on the role that angiotensin II plays in tissue fibrosis, as well as current and potential therapies targeting this system.

The elemental (Si, Ti, Al, Mn, Ca, Zr) and carbon stable-isotope (δ 13 C) geochemistry of a biostratigraphically well-constrained Cenomanian–Turonian (Upper Cretaceous) Chalk succession on the Isle of Wight, southern England, shows systematic variation that corresponds closely to a published sequence stratigraphic model for the Cenomanian. Six sequences and their constituent systems tracts, defined elsewhere using sedimentological criteria, are clearly distinguishable from bulk-sediment elemental profiles, and an additional Upper Cenomanian sequence previously identified in Spain is recognized in England from these geochemical data. The manganese curve is particularly instructive, exhibiting minima around sequence boundaries and through lowstands, rising values from the transgressive surfaces through transgressive systems tracts, maxima around maximum flooding surfaces, and declining values through highstands. Silica and trace-element (Ti, Zr) aluminium ratios peak around transgressive surfaces and maximum flooding surfaces, indicating pulses of increased siliciclastic input. Positive δ 13 C excursions are confirmed at the base of the Middle Cenomanian and spanning the Cenomanian–Turonian boundary but are not evident in other sequences. Variation in Mn is related to bulk sedimentation rate and detrital versus biogenic supply, which control the Mn flux and the efficiency of the diagenetic Mn ‘pump’ that leads to elevated Mn contents in sediments. Manganese peaks do not generally correlate with positive δ 13 C excursions, and although near-coincident Mn and δ 13 C peaks occur around the Cenomanian–Turonian boundary, the former is not necessarily linked to the oceanic anoxic event occurring at that time. The global oceanic Mn flux may have been enhanced during the Cenomanian as a result of hydrothermal activity during rapid sea-floor spreading and oceanic plateau formation. Elemental chemostratigraphy provides a new tool for developing sequence stratigraphic models in pelagic and hemipelagic carbonate successions.

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A novel way to process polarimetric radar data collected via plan-position indicator (PPI) scans and display those data in a time-height format is introduced. The columnar vertical profile (CVP) methodology uses radar data collected via multiple elevation scans, limited to data within a set region in range and azimuth relative to the radar, to create vertical profiles of polarimetric radar data representative of that limited region in space. This technique is compared to others existing in the literature, and various applications are discussed. Polarimetric ice microphysical retrievals are performed on CVPs created within the stratiform rain region of two mesoscale convective systems sampled during two field campaigns, where CVPs follow the track of research aircraft. Aircraft in situ data are collocated to microphysical retrieval data, and the accuracy of these retrievals is tested against other retrieval techniques in the literature.

Negative pressure wound therapy (NPWT) promotes healing by evenly applying negative pressure on the surface of the wound. The system consists of a sponge, a semiocclusive barrier, and a fluid collection system. Its effectiveness is explained by four main mechanisms of action, including macrodeformation of the tissues, drainage of extracellular inflammatory fluids, stabilization of the environment of the wound, and microdeformation. Rarely will complications linked to NPWT occur, but special care must be taken to prevent events such as toxic shock syndrome, fistulization, bleeding, and pain. New NPWT modalities have been recently developed to make NPWT suitable for a wider variety of wounds. These include NPWT with instillation therapy (NPWTi-d), different cleansing options, and application of NPWT on primarily closed incisions. Finally, vacuum-assisted wound closure therapy has been demonstrated to be efficient for various clinical settings, such as the management of diabetic foot ulcers, pressure ulcerations, chronic wounds, and skin grafts.

Unicoronal craniosynostosis predisposes to ophthalmologic abnormalities such as strabismus, astigmatism, and amblyopia. The authors explored the ophthalmologic outcomes following fronto-orbital advancement (FOA). A systematic search of PubMed, Embase, and the Cochrane Library was conducted. Included studies reported postoperative rates of strabismus, astigmatism, and/or amblyopia. Two independent reviewers performed screening and extracted data including preoperative rates, laterality and severity of findings, need for ocular surgery, and timing of FOA. Methodologic quality was assessed using the Methodologic Index for Non-Randomized Studies scale and American Society of Plastic Surgeons Evidence Rating Scale for Therapeutic Studies. A total of 231 abstracts were screened. Sixteen articles were eligible for qualitative synthesis including 13 case series and 3 retrospective comparative studies. Nine studies contained both preoperative and postoperative data, but for strabismus only. Postoperative prevalence of strabismus was 19% to 100%. Rates increased in 4 studies and decreased in 3. Incidences of new and resolved cases of strabismus were 0% to 60% and 0% to 33%, respectively. Twenty-five percent to 100% of patients required strabismus surgery. Postoperative rates of astigmatism were 15% to 92%. Fourteen percent to 41% had clinically significant anisometropia, predisposing to amblyopia. The postoperative prevalence of amblyopia was 3% to 56%. In summary, FOA does not appear to reduce rates of strabismus, astigmatism, or amblyopia. In addition, surgery carries the risk of iatrogenic strabismus. Earlier intervention and endoscopic techniques may reduce prevalence and severity, but additional research is required.

Patients with aneurysmal subarachnoid hemorrhage are at high risk of complications, including rebleeding, delayed cerebral ischemia, cerebral infarction, and death. This review presents a practical approach for managing this condition and its complications.

Polarimetric radar observations from the NEXRAD WSR-88D operational radar network in the contiguous United States, routinely available since 2013, are used to reveal three prominent microphysical signatures in landfalling tropical cyclones: 1) hydrometeor size sorting within the eyewall convection, 2) vertical displacement of the melting layer within the inner core, and 3) dendritic growth layers within stratiform regions of the inner core. Size sorting signatures within eyewall convection are observed with greater frequency and prominence in more intense hurricanes, and are observed predominantly within the deep-layer environmental wind shear vector-relative quadrants that harbor the greatest frequency of deep convection (i.e., downshear and left-of-shear). Melting layer displacements are shown exceed 1 km in altitude compared to melting layer altitudes in outer rainbands and are complemented by analyses of archived dropsonde data. Dendritic growth and attendant snow aggregation signatures in the inner core are found to occur more often when echo top altitudes are low (≤10 km ASL), nearer the –15° C isotherm commonly associated with dendritic growth. These signatures, uniquely observed by polarimetric radar, provide greater insight into the physical structure and thermodynamic characteristics of tropical cyclones, which are important for improving rainfall estimation and the representation of tropical cyclones in numerical models.